source of harm to our patients and puts us at increased risk
for COVID-19 infiltration. To cause a nosocomial outbreak,
it will take just one patient with occult COVID-19 who is
hospitalized, tests negative for influenza virus, and is taken
off precautions despite persistent respiratory symptoms. Or
just one visitor with COVID-19 and mild respiratory symptoms
who is permitted free access to the hospital because it
does not have an active screening and exclusion policy for
visitors with respiratory tract symptoms. Or just one infected
healthcare worker who decides to soldier through a shift
despite a sore throat and runny nose.”
Experts are placing renewed emphasis on common-sense
and evidence-based practices, including respiratory hygiene
and placing restrictions on patients, visitors, and healthcare
workers with even mild symptoms of upper respiratory
tract infection.
Klompas (2020) adds, “Potential policies to consider
include the following: 1) screening all visitors for any
respiratory symptoms that may be related to a virus,
including fever, myalgias, pharyngitis, rhinorrhea, and
cough, and excluding them from visiting until they are
better; 2) restricting healthcare workers from working if
they have any upper respiratory tract symptoms, even in
the absence of fever; and 3) screening all patients, testing
for all respiratory viruses (including SARS-CoV-2) in those
with positive screening results regardless of illness severity,
and using precautions (single rooms, contact precautions,
droplet precautions, and eye protection) for patients with
respiratory syndromes for the duration of their symptoms
regardless of viral test results. A collateral benefit is that if
a patient is subsequently diagnosed with COVID-19, staff
who used these precautions will be considered minimally
exposed and will be able to continue working. None
of these measures will be easy. Restricting visitors will
be psychologically difficult for patients and loved ones,
maintaining respiratory precautions for the duration of
patients’ symptoms will strain supplies in all hospitals and
bed capacity in hospitals that depend on shared rooms,
and preventing health care providers with mild illness from
working will compromise staffing. But if we are frank
about the morbidity and mortality of all respiratory viruses,
including SARS-CoV-2, this is the best thing we can do
for our patients and colleagues regardless of COVID-19.”
Transmission Potential of SARS-CoV-2 in Viral
Shedding
From left, Mark Rupp, MD, chief of infectious diseases, and John Lowe, PhD,
UNMC assistant vice chancellor for inter-professional health security training
and education
www.healthcarehygienemagazine.com • april 2020
Scientists from UNMC and Nebraska Medicine spoke
Sunday on a recently published study, describing patterns of
transmission in COVID-19. The study did provide additional
evidence of SARS-CoV-2 environmental contamination in
COVID-19 patient-care areas, finding levels of genetic ma-
terial from the COVID-19 virus contamination on commonly
used surfaces, in the air of rooms of COVID-19 patients and
in hallways outside of rooms.
“We are being very careful in the care of patients with
COVID-19 or patients suspected to have COVID-19, and
the study doesn’t change very much in the precautions
that people should take,” says Mark Rupp, MD, chief of
the UNMC Division of Infectious Diseases.
Rupp says that there was widespread contamination
within the patient-care environment and evidence of the
genetic material from the virus could be recovered in some
air samples, confirming the importance of disinfecting the
patient-care environment, further adding that COVID-19
transmission seems to be much like influenza and not like
airborne diseases such as chicken pox or measles. He added
that influenza virus can also sometimes be found in the air in
patient rooms particularly associated with aerosol generating
procedures — such as intubation or bronchoscopy.
“It doesn’t appear to spread like classic, airborne-spread
viruses,” he says. “We don’t have evidence at this point that
COVID-19 would spread in such a fashion, so we need to
continue to emphasize the known methods of transmission
and the ways to combat such transmission. We are caring
for patients known or suspected to have COVID-19 with
special precautions, and we recently introduced universal
mask use for all personnel in patient-care areas. “
John Lowe, PhD, co-author of the study and vice
chancellor for interprofessional health security training and
education, says the study was performed to investigate how
the virus was spread so as to protect healthcare workers.
“We were not incredibly surprised by any of the results
we found,” he says. “We did confirm the presence of the
genetic material from the virus throughout the environment
on what we refer to as high-touch surfaces or surfaces of
interest — toilets, cell phones, personal items, countertops,
doorknobs. We also did identify a number of samples that
detected the virus genes in the air, which confirmed for us
the value in prioritizing respiratory protection when possible
and prioritizing negative-pressure environments to provide
direct patient care to these individuals.”
“Our team was already taking precautions with the initial
patients we cared for,” says James Lawler, MD, co-author
of the report, an infectious diseases expert and a director
of the Global Center for Health Security at UNMC. “This
report reinforces our suspicions. It’s why we have maintained
COVID patients in well-equipped rooms and will continue to
make efforts to do so — even with an increase in the number
of patients. Our healthcare workers providing care will be
equipped with the appropriate level of personal protective
equipment. Obviously, more research is required to be able
to fully characterize environmental risk.”
“Studies like these are needed to understand proper
precautions for healthcare workers, first responders and
others who care for the ill and are needed to combat this
pandemic,” says Joshua Santarpia, PhD, co-author of the
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